Development and long-term fate of a cellular lining in fibrous polyurethane vascular prostheses implanted in the dog carotid and femoral artery. A scanning and light microscopical study up to 53 months after implantation.

The development and long-term fate of the inner cellular lining in 72 small caliber (3 mm inner diameter) fibrous polyurethane vascular prostheses explanted from dog carotid and/or femoral arteries at times ranging from 1.5 weeks up to 53 months after implantation were studied by scanning electron and light microscopy. A continuous cellular ingrowth from the vascular stumps into the 3 cm long prostheses was observed, which eventually resulted in a complete cellular lining 6 months after implantation. No other ways of endothelialization were noted. In fully endothelialized prostheses, the cellular ingrowth extended approximately 8 mm into the prostheses and consisted of several layers of fibroblasts and smooth muscle cells, covered by a very thin endothelioid cell layer. The newly developed lining was firmly anchored onto the inner prosthetic surface by means of cellular protrusions extended into the fibrous texture of the prosthetic wall. It was concluded that under experimental conditions in the dog complete endothelialization can be obtained in fibrous polyurethane vascular prostheses and that the lining remained thin and stable throughout the observation period of 53 months after implantation.     

Prospective study of the evolution of Raynaud's phenomenon

Seventy-four patients with Raynaud's phenomenon and no associated illness were followed prospectively to determine whether a secondary disease would develop, and clinical and laboratory assessments were performed at study entry to determine their association with the subsequent development of disease. After an average of 2.7 years of follow-up (range 0.5 to 5.7 years), outcome information was available on 58 persons (78.4 percent). A connective tissue disease developed in 11 (19.0 percent): three systemic sclerosis and eight CREST syndrome. The two variables at entry most strongly associated with the subsequent development of a connective tissue disease were an abnormal nailfold capillary pattern (adjusted odds ratio = 26.82, 95 percent confidence interval = 4.69, 153.2) and an abnormal pulmonary function test result (odds ratio = 4.78, 95 percent confidence interval = 1.02, 22.41). The positive association of an abnormal barium esophagram, presence of antinuclear antibodies, and cutaneous abnormalities did not reach statistical significance. The development of connective tissue diseases in this group of patients is not rare. An abnormal nailfold capillary pattern is strongly associated with the subsequent development of systemic sclerosis or CREST syndrome in patients with Raynaud's phenomenon.     

MR characteristics of prostatic carcinoma and benign prostatic hyperplasia at 1.5 T

Sixty-one patients with histologically proven disorders of the prostate [prostatic carcinoma (PC), 41; benign prostatic hyperplasia (BPH), 9; PC and BPH, 11] underwent magnetic resonance imaging at 1.5 T. Using single [spin echo (SE) 400/30] and dual (SE 1,600/30, 90) SE sequences, multislice contiguous scans were obtained in transverse, sagittal, and coronal planes through the prostate. In 27 patients (PC 14, BPH 6, PC and BPH 7) multiecho sequences with eight echoes (SE 1,600/30, 60, 90, 120, 150, 180, 210, 240) were acquired and T2 images were calculated in the planes with best depiction of circumscribed prostatic pathology. In these patients the Bhattacharyya coefficient, a quantitative criterion for the discrimination between normal and pathological tissue, derived by means of mathematical decision theory, was applied. This analysis showed the best discrimination between PC and normal prostate with echo time (TE) 90 and 120 ms [error rate (ER) for confusing these tissues 20-30%]. There was no significant difference between the signal intensities of PC and BPH at any parameter setting, but PC could be discriminated from the compressed peripheral glandular regions that often accompany BPH [minimal ER (20-30%) at TE 90 and 120 ms]. This distinction is of clinical value, since PC usually arises in the periphery of the prostate. Calculated T2 images did not show advantages for the detection of PC.     

An open-label efficacy pilot study with pimecrolimus cream 1% in adults with facial seborrhoeic dermatitis infected with HIV

BACKGROUND: Seborrhoeic dermatitis (SD) is a common dermatosis in human immunodeficiency virus (HIV)-positive patients, many of whom do not respond satisfactorily to conventional topical treatments such as corticosteroids and antifungals. OBJECTIVE: A pilot study to investigate the efficacy and tolerability of pimecrolimus cream 1% in HIV-positive patients with facial SD. METHODS: In a single-centre study, 21 HIV-infected patients with mild to severe SD were treated twice daily with pimecrolimus cream 1% for 14 days. Thereafter, treatment was discontinued and patients followed up for 5 weeks. Skin involvement at baseline and on days 7, 14, 21, 35 and 49 was assessed using a four-point clinical score and digital photography. MAIN OUTCOME MEASURES: Efficacy and safety of pimecrolimus cream 1% treatment and incidence of relapse in the follow-up phase. Results Marked improvement was seen in clinical parameters at day 7, with >or= 90% patients clear of symptoms at day 14. Relapse was observed at day 35 but signs were milder than at baseline. All patients responded to therapy, despite their immunological status. Pimecrolimus did not alter CD4(+) and CD8(+) T-cell counts or viral load during the treatment period. CONCLUSION: Pimecrolimus cream represents a new, effective therapeutic option for facial SD in HIV patients.     

The presence of an HLA-identical sibling donor has no impact on outcome of patients with high-risk MDS or secondary AML (sAML) treated with intensive chemotherapy followed by transplantation: results of a prospective study of the EORTC, EBMT, SAKK and GIMEMA Leukemia Groups (EORTC study 06921).

This report used the framework of a large European study to investigate the outcome of patients with and without an HLA-identical sibling donor on an intention-to-treat basis. After a common remission-induction and consolidation course, patients with an HLA-identical sibling donor were scheduled for allogeneic transplantation and patients lacking a donor for autologous transplantation. In all, 159 patients alive at 8 weeks from the start of treatment were included in the present analysis. In total, 52 patients had a donor, 65 patients did not have a donor and in 42 patients the availability of a donor was not assessed. Out of 52 patients, 36 (69%) with a donor underwent allogeneic transplantation (28 in CR1). Out of 65 patients, 33 (49%) received an autograft (27 in CR1). The actuarial survival rates at 4 years were 33.3% (s.e. = 6.7%) for patients with a donor and 39.0% (s.e. = 6.5%) for patients without a donor (P = 0.18). Event-free survival rates were 23.1% (s.e. = 6.2%) and 21.5% (s.e. = 5.3%), respectively (P = 0.66). Correction for alternative donor transplants did not substantially alter the survival of the group without a donor. Also, the survival in the various cytogenetic risk groups was not significantly different when comparing the donor vs the no-donor group. This analysis shows that patients with high-risk myelodysplastic syndrome and secondary acute myeloid leukemia may benefit from both allogeneic and autologous transplantation. We were unable to demonstrate a survival advantage for patients with a donor compared to patients without a donor.     

In vivo measurement of the shear modulus of the human vocal fold: interim results from eight patients

The shear modulus of the vocal fold is an essential parameter required to enhance our understanding of how the vocal fold operates, to develop mathematical models of phonatation, and to provide benchmarks to quantify the effectiveness of surgical procedures. The authors announced the successful deployment of an instrument to measure vocal fold elasticity in vivo last year, and now present the data taken from eight patients in vivo. The shear modulus was measured at the mid-membranous point, in a transverse direction with respect to the axis drawn between the anterior commissure and vocal process. The range of mean shear modulus results is 701–2,225 Pa, with a mean value of 1,371 Pa.